Epidemiological burden of depression and its impact on adherence to oral hypoglycemic agents and related economic outcomes in patients with type 2 diabetes

Presence of depression in patients with type 2 diabetes may affect their adherence to oral hypoglycemics and consequently glycemic control and economic outcomes. These potential effects may be more significant when one considers that depression is highly prevalent in patients with diabetes. This study involved two phases. Phase one of the study examined the epidemiological relationship between depression and type 2 diabetes. Phase two of the study examined the impact of depression on patterns of use and adherence to oral hypoglycemics in newly diagnosed type 2 diabetes patients. Impact of depression on expenditures related to type 2 diabetes and overall health care was also estimated. The study also tested the mediating influence of adherence between depression and type 2 diabetes expenditures. Results of phase one of the study indicated that depression was more prevalent in patients with type 2 diabetes as compared to a control group. Results also indicated that females with depression were more likely to develop type 2 diabetes as compared to those without depression. Phase two results indicated that patients without depression had a more favorable pattern of oral hypoglycemic use with a significantly lower proportion of non-depressed patients switching, augmenting, or discontinuing their oral hypoglycemics as compared to depressed patients. Depressed patients were also found to have significantly lower adherence to oral hypoglycemics as compared to non-depressed patients. Multivariate analyses indicated that patients with depression incurred 21.30% higher type 2 diabetes related costs as compared to non-depressed patients. This difference was primarily due to a higher probability of an ER/hospitalization episode in depressed patients. Similarly, patients with depression had 32.10% higher overall health care costs as compared to patients without depression. Depression was associated with increased costs in all areas of health care such as ER/hospitalization, outpatient, and prescription costs. Mediation analysis indicated that adherence to oral hypoglycemics was not a mediator between depression and type 2 diabetes related expenditures. Thus, depression could have potentially impacted type 2 diabetes related outcomes directly through a physiological effect on glycemic levels or indirectly through its impact on adherence to other behaviors such as diet or exercise

The Impact of an Immunization Training Certificate Program on the Perceived Knowledge, Skills and Attitudes of Pharmacy Students Toward Pharmacy-Based Immunizations

Objective: To assess the impact of a national immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations. Methods: The study design utilized a pre- and post- survey administered to pharmacy students before and after the American Pharmacists Association’s (APhA) Pharmacy-Based Immunization Delivery program. The primary outcome explored was a change in the perceived knowledge, skills, and attitudes of the pharmacy students. A five-point Likert scale (i.e. strongly agree = 5, strongly disagree = 1) was used for measuring the main outcomes, which was summated by adding the individual item scores in each section to form a composite score for each outcome. Results: The certificate training program resulted in a significant improvement in knowledge (38.5% increase in score, p\u3c0.001) and skills (34.5% increase in score, p\u3c0.001), but not attitudes (1% increase in score, p=0.210). Conclusions: The national immunization training certificate program had a positive impact on the perceived knowledge and skills of pharmacy students. However, no change was observed regarding students’ perceived attitudes toward pharmacy-based immunizations

Impact of Decmedetomidine on Opioid and Benzodiazepine Dosing Requirements in Children.

Poster presented at: Annual Update on Pediatric Cardiovascular Disease; February 2008; Scottsdale Arizona

Enhanced student learning and scholarly productivity through capstone projects

Abstract from the American Association of Colleges of Pharmacy/Association of Faculties of Pharmacy of Canada Annual Meeting, Chicago, IL, July 16-24, 2008

Enhanced student learning and public health awareness through capstone projects

Abstract from the 110th Annual Meeting of the American Association of Colleges of Pharmacy, Boston, MA, July 18-22, 2009